Organization
RENAISSANCE FAMILY PRACTICE, INC.
Active
Parent organization
MEDVANTX, INC.
Other names
Renaissance Family Practice - Glenshaw
Organization subpart
Yes
Provider details
NPI number
Legal business name
MEDVANTX, INC.
Authorized official
KENNY HEINE (DIRECTOR OF OPERATIONS)
(858) 625-2990
Entity
Organization
Contact information
Practice address
619 MOUNT ROYAL BLVD, PITTSBURGH, PA 15223-1225
(412) 487-4422
Mailing address
5626 OBERLIN DR, SUITE 110, SAN DIEGO, CA 92121-1705
Taxonomy
Speciality
Code
Description
License number
State
332900000X
Non-Pharmacy Dispensing Site
Primary
MD417572
PA
Other
Enumeration date
02/13/2007
Last updated
10/17/2012
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